{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:32:11Z","timestamp":1777422731225,"version":"3.51.4"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Robot. AI"],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Children and adolescents with neurological impairments face reduced participation and independence in daily life activities due to walking difficulties. Existing assistive devices often offer insufficient support, potentially leading to wheelchair dependence and limiting physical activity and daily life engagement. Mobile wearable robots, such as exoskeletons and exosuits, have shown promise in supporting adults during activities of daily living but are underexplored for children.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We conducted a cross-sectional study to examine the potential of a cable-driven exosuit, the Myosuit, to enhance walking efficiency in adolescents with diverse ambulatory impairments. Each participant walked a course including up-hill, down-hill, level ground walking, and stairs ascending and descending, with and without the exosuit\u2019s assistance. We monitored the time and step count to complete the course and the average heart rate and muscle activity. Additionally, we assessed the adolescents\u2019 perspective on the exosuit\u2019s utility using a visual analog scale.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Six adolescents completed the study. Although not statistically significant, five participants completed the course with the exosuit\u2019s assistance in reduced time (time reduction range: [-3.87, 17.42]%, <jats:italic>p<\/jats:italic>-value: 0.08, effect size: 0.88). The number of steps taken decreased significantly with the Myosuit\u2019s assistance (steps reduction range: [1.07, 15.71]%, <jats:italic>p<\/jats:italic>-value: 0.04, effect size: 0.90). Heart rate and muscle activity did not differ between Myosuit-assisted and unassisted conditions (<jats:italic>p<\/jats:italic>-value: 0.96 and 0.35, effect size: 0.02 and 0.42, respectively). Participants generally perceived reduced effort and increased safety with the Myosuit\u2019s assistance, especially during tasks involving concentric contractions (e.g., walking uphill). Three participants expressed a willingness to use the Myosuit in daily life, while the others found it heavy or too conspicuous.<\/jats:p><jats:p><jats:bold>Discussion:<\/jats:bold> Increased walking speed without increasing physical effort when performing activities of daily living could lead to higher levels of participation and increased functional independence. Despite perceiving the benefits introduced by the exosuit\u2019s assistance, adolescents reported the need for further modification of the device design before using it extensively at home and in the community.<\/jats:p>","DOI":"10.3389\/frobt.2024.1335733","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T04:57:20Z","timestamp":1710305840000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Enhancing walking efficiency of adolescents with neurological impairments using an exosuit for ambulatory activities of daily living"],"prefix":"10.3389","volume":"11","author":[{"given":"Chiara","family":"Basla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Mariani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Riener","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubertus J. A.","family":"van Hedel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1097\/00004694-199611000-00010","article-title":"Strategies for increasing walking speed in diplegic cerebral palsy","volume":"16","author":"Abel","year":"1996","journal-title":"J. Pediatr. Orthop."},{"key":"B2","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1177\/0278364914562476","article-title":"A biologically inspired soft exosuit for walking assistance","volume":"34","author":"Asbeck","year":"2015","journal-title":"Int. J. Rob. Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"eaai9084","DOI":"10.1126\/scitranslmed.aai9084","article-title":"A soft robotic exosuit improves walking in patients after stroke","volume":"9","author":"Awad","year":"2017","journal-title":"Sci. Transl. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12984-020-00702-5","article-title":"The ReWalk ReStoreTM soft robotic exosuit: a multi-site clinical trial of the safety, reliability, and feasibility of exosuit-augmented post-stroke gait rehabilitation","volume":"17","author":"Awad","year":"2020","journal-title":"J. Neuroeng Rehabil."},{"key":"B5","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s12984-022-01103-6","article-title":"Usability of an exosuit in domestic and community environments","volume":"19","author":"Basla","year":"2022","journal-title":"J. Neuroeng Rehabil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1111\/j.1469-8749.2002.tb00816.x","article-title":"Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy","volume":"44","author":"Beckung","year":"2007","journal-title":"Dev. Med. Child. Neurol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"248","DOI":"10.2522\/ptj.20060157","article-title":"Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically","volume":"87","author":"Bjornson","year":"2007","journal-title":"Phys. Ther."},{"key":"B8","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1109\/tts.2020.2974990","article-title":"Trust and pediatric exoskeletons: a comparative study of clinician and parental perspectives","volume":"1","author":"Borenstein","year":"2020","journal-title":"IEEE Trans. Technol. Soc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"702137","DOI":"10.3389\/frobt.2021.702137","article-title":"A pediatric knee exoskeleton with real-time adaptive control for overground walking in ambulatory individuals with cerebral palsy","volume":"8","author":"Chen","year":"2021","journal-title":"Front. Robot. AI"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2431-11-1","article-title":"Becoming and staying physically active in adolescents with cerebral palsy: protocol of a qualitative study of facilitators and barriers to physical activity","volume":"11","author":"Claassen","year":"2011","journal-title":"BMC Pediatr."},{"key":"B11","volume-title":"Statistical power analysis for the behavioural sciences","author":"Cohen","year":"1988"},{"key":"B12","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12984-022-01055-x","article-title":"Effects of ATLAS 2030 gait exoskeleton on strength and range of motion in children with spinal muscular atrophy II: a case series","volume":"19","author":"Cumplido-Trasmonte","year":"2022","journal-title":"J. Neuroeng Rehabil."},{"key":"B13","doi-asserted-by":"publisher","first-page":"753226","DOI":"10.3389\/fped.2021.753226","article-title":"ATLAS2030 pediatric gait exoskeleton: changes on range of motion, strength and spasticity in children with cerebral palsy. A case series study","volume":"9","author":"Delgado","year":"2021","journal-title":"Front. Pediatr."},{"key":"B15","doi-asserted-by":"publisher","first-page":"341","DOI":"10.3233\/nre-192805","article-title":"Associations between walking speed and participation, according to walking status in individuals with chronic stroke","volume":"45","author":"Faria-Fortini","year":"2019","journal-title":"NeuroRehabilitation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.2522\/ptj.20060116","article-title":"Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings","volume":"87","author":"Fowler","year":"2007","journal-title":"Phys. Ther."},{"key":"B17","article-title":"Comparing optimized exoskeleton assistance of the hip, knee, and ankle in single and multi-joint configurations","volume":"1","author":"Franks","year":"2021"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e71","DOI":"10.1016\/j.pedn.2022.09.014","article-title":"Using a robotic exoskeleton at home: an activity tolerance case study of a child with spinal muscular atrophy","volume":"67","author":"Garces","year":"2022","journal-title":"J. Pediatr. Nurs."},{"key":"B19","doi-asserted-by":"publisher","first-page":"124","DOI":"10.12965\/jer.1632552.276","article-title":"Metabolic, cardiorespiratory, and neuromuscular fitness performance in children with cerebral palsy: a comparison with healthy youth","volume":"12","author":"Garc\u00eda","year":"2016","journal-title":"J. Exerc Rehabil."},{"key":"B20","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.cbpa.2010.09.011","article-title":"The heart rate method for estimating metabolic rate: review and recommendations","volume":"158","author":"Green","year":"2011","journal-title":"Comp. Biochem. Physiol. - A Mol. Integr. Physiol."},{"key":"B21","doi-asserted-by":"crossref","DOI":"10.1109\/ICORR.2019.8779375","article-title":"User-driven walking assistance: first experimental results using the MyoSuit","author":"Haufe","year":"2019"},{"key":"B22","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12984-021-00946-9","article-title":"Learning to walk with a wearable robot in 880 simple steps: a pilot study on motor adaptation","volume":"18","author":"Haufe","year":"2021","journal-title":"J. Neuroeng Rehabil."},{"key":"B23","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12984-020-00765-4","article-title":"Activity-based training with the Myosuit: a safety and feasibility study across diverse gait disorders","volume":"17","author":"Haufe","year":"","journal-title":"J. Neuroeng Rehabil."},{"key":"B24","first-page":"390","article-title":"Increasing exercise intensity during outside walking training with a wearable robot","author":"Haufe","year":""},{"key":"B25","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/s1050-6411(00)00027-4","article-title":"Development of recommendations for SEMG sensors and sensor placement procedures","volume":"10","author":"Hermens","year":"2000","journal-title":"J. Electromyogr. Kinesiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/s0966-6362(01)00206-5","article-title":"Speed dependence of averaged EMG profiles in walking","volume":"16","author":"Hof","year":"2002","journal-title":"Gait Posture"},{"key":"B27","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ridd.2017.12.005","article-title":"Changes in lower extremity strength may be related to the walking speed improvements in children with cerebral palsy after gait training","volume":"73","author":"Hoffman","year":"2018","journal-title":"Res. Dev. Disabil."},{"key":"B28","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.gaitpost.2022.09.082","article-title":"Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: a systematic review","volume":"98","author":"Hunt","year":"2022","journal-title":"Gait Posture"},{"key":"B29","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/phm.0b013e31804a7d00","article-title":"Factors associated with health-related quality of life in chronic spinal cord injury","volume":"86","author":"Jain","year":"2007","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"B30","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1126\/science.aav7536","article-title":"Reducing the metabolic rate of walking and running with a versatile, portable exosuit","volume":"365","author":"Kim","year":"2019","journal-title":"Science"},{"key":"B31","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1589\/jpts.2017.822","article-title":"The association between the maximum step length test and the walking efficiency in children with cerebral palsy","volume":"29","author":"Kimoto","year":"2017","journal-title":"J. Phys. Ther. Sci."},{"key":"B32","doi-asserted-by":"publisher","first-page":"eaam9145","DOI":"10.1126\/scitranslmed.aam9145","article-title":"A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy","volume":"9","author":"Lerner","year":"","journal-title":"Sci. Transl. Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"13512","DOI":"10.1038\/s41598-017-13554-2","article-title":"The effects of exoskeleton assisted knee extension on lower-extremity gait kinematics, kinetics, and muscle activity in children with cerebral palsy","volume":"7","author":"Lerner","year":"","journal-title":"Sci. Rep."},{"key":"B34","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1109\/tnsre.2016.2595501","article-title":"A robotic exoskeleton for treatment of crouch gait in children with cerebral palsy: design and initial application","volume":"25","author":"Lerner","year":"","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1109\/tnsre.2018.2870756","article-title":"An untethered ankle exoskeleton improves walking economy in a pilot study of individuals with cerebral palsy","volume":"26","author":"Lerner","year":"2018","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jbiomech.2017.03.004","article-title":"Effects of step length and step frequency on lower-limb muscle function in human gait","volume":"57","author":"Lim","year":"2017","journal-title":"J. Biomech."},{"key":"B37","doi-asserted-by":"crossref","DOI":"10.1097\/01.blo.0000058884.03274.d9","article-title":"Backpacks in children","volume-title":"Clinical orthopaedics and related research","author":"Mackenzie","year":"2003"},{"key":"B38","doi-asserted-by":"publisher","first-page":"673","DOI":"10.3390\/medicina56120673","article-title":"Effect of the hybrid assistive limb on the gait pattern for cerebral palsy","volume":"56","author":"Mataki","year":"2020","journal-title":"Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1016\/j.braindev.2018.04.004","article-title":"Robot-assisted training using Hybrid Assistive Limb\u00ae for cerebral palsy","volume":"40","author":"Matsuda","year":"2018","journal-title":"Brain Dev."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.2522\/ptj.20150401","article-title":"Effectiveness of rehabilitation interventions to improve gait speed in children with cerebral palsy: systematic review and Meta-Analysis","volume":"96","author":"Moreau","year":"2016","journal-title":"Phys. Ther."},{"key":"B41","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1097\/01241398-200001000-00017","article-title":"Reliability and validity of the Gillette functional assessment questionnaire as an outcome measure in children with walking disabilities","volume":"20","author":"Novacheck","year":"2000","journal-title":"J. Pediatr. Orthop."},{"key":"B42","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1109\/tnsre.2020.2965029","article-title":"Ankle exoskeleton assistance can improve over-ground walking economy in individuals with cerebral palsy","volume":"28","author":"Orekhov","year":"2020","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"B43","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12984-016-0150-9","article-title":"A biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking","volume":"13","author":"Panizzolo","year":"2016","journal-title":"J. Neuroeng Rehabil."},{"key":"B44","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/dmcn.14471","article-title":"ICF mobility and self-care goals of children in inpatient rehabilitation","volume":"62","author":"Rast","year":"2020","journal-title":"Dev. Med. Child. Neurol."},{"key":"B46","first-page":"102","article-title":"Energetics of walking","volume-title":"Human walking","author":"Rose","year":"1994"},{"key":"B47","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-22327-4_10","volume-title":"EXOtrainer Project clinical evaluation of gait training with exoskeleton in children with spinal muscular atrophy","author":"Sanz-Merodio","year":"2020"},{"key":"B48","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1080\/09638280400018437","article-title":"Participation and activity performance of students with cerebral palsy within the school environment","volume":"27","author":"Schenker","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"B49","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3389\/fnbot.2017.00057","article-title":"The myosuit: Bi-articular anti-gravity exosuit that reduces hip extensor activity in sitting transfers","volume":"11","author":"Schmidt","year":"2017","journal-title":"Front. Neurorobot"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1542\/peds.2006-0298","article-title":"Growth and health in children with moderate-to-severe cerebral palsy","volume":"118","author":"Stevenson","year":"2006","journal-title":"Pediatrics"},{"key":"B51","article-title":"The need to report effect size estimates revisited. An overview of some recommended measures of effect size","volume":"1","author":"Tomczak","year":"2014","journal-title":"Trends Sport Sci."},{"key":"B52","volume-title":"Counted, Included: using data to shed light on the well-being of children with disabilities","year":"2021"},{"key":"B53","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1002\/jor.1100060208","article-title":"Energy\u2010speed relationship of walking: standard tables","volume":"6","author":"Waters","year":"1988","journal-title":"J. Orthop. Res."}],"container-title":["Frontiers in Robotics and AI"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frobt.2024.1335733\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T04:57:26Z","timestamp":1710305846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frobt.2024.1335733\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,13]]},"references-count":51,"alternative-id":["10.3389\/frobt.2024.1335733"],"URL":"https:\/\/doi.org\/10.3389\/frobt.2024.1335733","relation":{},"ISSN":["2296-9144"],"issn-type":[{"value":"2296-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,13]]},"article-number":"1335733"}}